General Medical Information

Hypopharyngeal Cancer Surgery

GARY L. SCHECHTER
J. TRAD WADSWORTH

The rules governing resection of hypopharyngeal cancers reflect the anatomy and pathology of the region. It is not possible to present the details of all surgical procedures used for resection of all cancers of the hypopharynx in a single chapter. Therefore, in some circumstances, only specific features of the surgical approach are presented.

Neck dissection is performed in most patients with cancer of the hypopharynx, and bilateral neck dissection is recommended in patients with medial wall pyriform sinus disease. As outlined in the earlier section on Pathology, the incidence of gross and microscopic lymph node metastases is high in these lesions. Most patients present with large cervical lymph nodes. This, and the fact that the lateral neck must be entered for resection of most primary lesions, makes neck dissection an essential part of treatment and easily accessible. As noted in the text that follows, many of these cancers also require special attention to lymph node groups that are not routinely dissected. In rare situations, superior mediastinal dissection may be required to control paratracheal metastases. On the other hand, there are some small tumors that do no require entrance into the lateral neck for resection, i.e., small posterior hypopharyngeal cancers. If these patients also lack palpable nodes, postoperative radiation therapy may be considered for control of potential microscopic disease.